Bending or Breaking: Towards a Determination of Undue Hardship in Mental Health and Reproductive Care Among Hasidic (Ultra-Orthodox) Jews

Religious accommodation in healthcare has reached a point of tension. A religious patient finds it difficult to separate autonomous choices from religiously informed pronouncements. This is more pronounced withmore orthodox followers of a religion. Within modern Judaism, the Hasidic branch displays many features that attempt to reproduce features of 18th and 19th century Jewish life in the Russian Empire’s Pale of Settlement.Many, if not most families speak little English, are patriarchal and do not make medical decisions without rabbinical consultation. Further, the notion of mental illness is still taboo in this insular society. Rather, it is the result of theyatzar ha-rah or ‘bad spirit’ that can be exorcised via prayer and repentance.Another unique clinical encounter may be found in reproduction. The menstrual purity laws govern coitus and procreation and, can prevent natural pregnancy. There has been an increase in literature about whetherand how it is ethical to prescribe oral contraception to these women; not for normative purposes but rather, to align their cycle with the Biblical mandates. Moreover, the technicalities of reproductive technologies (includingspermatozoa testing) are more complex for the Hasidic community than for even Modern Orthodox Jews. Further, some literature suggests a rise in OCD or eating disorders related to keeping with strict reproductive laws. Literature will be drawn from the two epi-centers of Ultra-Orthodoxy: New York and Israel. Israel is particularly interesting as the hospitals are built around both secular medicine and Jewish law (halakha) However,they too wrestle with the question of accommodation, and may well provide useful examples to investigate at what point undue hardship can be invoked.